Cossi M.-J.,University of Limoges |
Gobron C.,Service de Physiologie Explorations Fonctionnelles |
Preux P.-M.,University of Limoges |
Chabriat H.,University Paris Diderot |
Houinato D.,University of Limoges
Cerebrovascular Diseases | Year: 2012
Background: Little is known about the burden of stroke in sub-Saharan Africa that may increase with the ongoing demographic and socioeconomic transition. This study aims to assess the prevalence of stroke, its related disability rate and consequences in the quality of daily life in an urban door- to-door survey in Cotonou, Benin. Methods: A three-phase door-to-door study was performed in two districts of Cotonou with a broad range of socioeconomic income. A population of 15,155 individuals aged ≥15 years was evaluated. The first phase consisted in screening of stroke in the population using the modified WHO questionnaire, the second phase included the medical evaluation of all suspected cases, and in the third phase the diagnosis of stroke was confirmed by CT scan evaluation. Results: Out of 15,155 subjects, 321 cases were identified as possible stroke cases. The diagnosis was confirmed in 70 cases. The crude prevalence of stroke was thus estimated to be 4.6/1,000 (8.7/1,000 and 7.7/1,000 adjusted to the WHO and SEGI World Population). The mean age of the patients at onset was 56 ± 13 years. Sixty percent of stroke survivors had a Rankin score ≥2, and CT scan was found abnormal in 90.0% of them. Conclusion: The stroke prevalence in urban areas of Cotonou is higher than that reported in other sub-Saharan countries, and the majority of stroke survivors present with good functional recovery and without severe disability in their everyday life. Copyright © 2012 S. Karger AG, Basel.
Cossi M.-J.,University of Limoges |
Preux P.-M.,University of Limoges |
Chabriat H.,University Paris Diderot |
Gobron C.,Service de Physiologie explorations Fonctionnelles |
Houinato D.,University of Limoges
Neuroepidemiology | Year: 2012
Background: Studies on the knowledge of stroke, its related risk factors and warning symptoms in the populations of Sub-Saharan Africa are scarce. No study has been performed in Benin until now. Methods: A door-to-door survey was performed in two districts of Cotonou with a broad socioeconomic range. 15,155 individuals aged ≥15 years were interviewed using a semi-structured questionnaire adapted from previous reports. Results: 15,155 individuals consented to participate in the survey. 14.1% correctly identified the brain as the affected organ in stroke. The most commonly identified risk factor was hypertension (34.5%). The most often cited warning signs of stroke were paralysis and hemiplegia (34.4%). Relatives were the major source of information about stroke (25.1%). In multivariate analysis, age, education level, occupation, self-reported risk factors of stroke, overweight and obesity were associated with at least one correct response to the questionnaire about stroke risk factors or symptoms. Conclusion: The awareness of stroke, and its risk factors and symptoms is low in Cotonou. The results suggest that specific education programs may improve people's knowledge of stroke and their awareness of related risk factors in Sub-Saharan African countries. © 2012 S. Karger AG, Basel.
Poupard L.,Novacor SA |
Philippe C.,Service de Physiologie Explorations Fonctionnelles |
Goldman M.D.,University of Texas at El Paso |
Sartene R.,Laboratoire dExplorations Fonctionnelles |
Mathieu M.,Laboratoire dExplorations Fonctionnelles
Sleep and Breathing | Year: 2012
Aim: Polysomnography (PSG) is the current standard for diagnosing sleep apnea syndrome (SAS). A reliable test would be useful to reduce the considerable resources required for PSG. Methods: We developed a new mathematical analysis, which quantifies amplitude variations of pulse oximetry (SpO 2) and heart rate (HR) throughout the night, allowing measurement of the total time in which ΔSpO 2 >4% and presented as a new oximetric index ventilatory hypoxemic index (VHI). VHI was compared prospectively with standard PSG parameters apnea - hypopnea index (AHI) and oxygen desaturation index (ODI) in 106 patients (aged, 57±14 years; BMI, 29±5 kg/m 2) suspected of having SAS. The criterion for diagnosis of SAS was AHI >15/h of sleep during PSG. The relationship between ΔSpO 2 and ΔHR was also investigated. Results: We observed a significant correlation between the AHI and VHI (R=0.87, p<0.0001). Using VHI >15 as the criterion for SpO 2, oximetry had a sensitivity of 81%, specificity of 98%, positive predictive value (PPV) of 98%, and negative predictive value (NPV) of 84% as a screening test for SAS. We also observed a clear linear relationship between ΔSpO 2 and ΔHR, and concomitant use of VHI and the ΔSpO 2/ΔHR slope improved the NPV to 90%. Conclusions: The present findings from wavelet-aggregate processing of oximeter data and the relationship between ΔSpO 2 and ΔHR show promise as a useful summary prediction of screening SAS. © Springer-Verlag 2011.
Hu H.,University of Paris Descartes |
Hu H.,Nanchang University |
Batteux F.,University of Paris Descartes |
Chereau C.,University of Paris Descartes |
And 7 more authors.
Journal of Pathology | Year: 2011
Renal ischaemia-reperfusion injury (IRI) is consecutive to tissue oxidative damage and cell apoptosis that lead to acute renal failure (ARF) in renal allografts. The aim of this study was to investigate the beneficial effects of a pretreatment by clopidogrel on renal IRI in mice. IRI was induced by bilateral renal ischaemia for 45 min followed by reperfusion. Sixty-two healthy male BALB/c mice were randomly assigned to one of the following groups: PBS + ischaemia-reperfusion (IR); clopidogrel + IR; PBS + sham IR; clopidogrel + sham IR. Clopidogrel (25 mg/kg) or PBS was administered per os to the animals via a gastric cannula 24 h before operation. All mice were given a single dose of clopidogrel or PBS. Renal function histological damage, renal cell apoptosis, renal antioxidant activities, and CD41 expression were determined 24 h after reperfusion. The survival rates were evaluated over 7 days. Animals pretreated with clopidogrel had lower plasma levels of blood urea nitrogen (BUN) and creatinine, lower histopathological scores, and improved survival rates following IR. Renal cell apoptosis induced by IR was decreased in kidneys of mice pretreated by clopidogrel, with an increase in Bcl-2 and Bcl-xL expression and a decrease in caspase-3, caspase-8, and Bax expression. Renal reduced glutathione, superoxide dismutase, and catalase activities were unmodified by the pretreatment with clopidogrel. However, clopidogrel resulted in an increased total antioxidant capacity of the kidney. Furthermore, pretreatment by clopidogrel decreased the number of CD41-positive cells. Thus, clopidogrel exerts protective effects on renal IRI in mice by abrogating renal cell apoptosis as a consequence of improved renal antioxidant capacity and could be tried as a novel therapeutic tool in renal IRI. Copyright © 2011 Pathological Society of Great Britain and Ireland. Copyright © 2011 Pathological Society of Great Britain and Ireland.
Nguyen The Tich S.,Angers University Hospital Center |
Cheliout-Heraut F.,Service de physiologie explorations fonctionnelles
Neurophysiologie Clinique | Year: 2015
Pediatric EEG in the intensive care unit (ICU) requires specific technical requirements in order to yield relevant data depending upon clinical scenario: diagnosis of electroclinical or subclinical seizures, their quantification before and after therapeutic changes and sometimes evaluation of severity of cortical dysfunction. The urgent nature of these indications implies the rapid set-up of the EEG system by qualified staff and possibility of maintaining the electrodes in place during long periods of time. Various techniques are available today for EEG monitoring, the interpretation of which depends on the contribution of an experienced physician. Among recent techniques, those most commonly used are trend curves obtained via signal analysis such as amplitude EEG (a-EEG) and density spectral array (DSA) or compressed spectral array (CSA). Trend curves enable the digital creation of a display graph containing several hours of transformed and compressed EEG recorded data. Visualized on one sole display graph, these trend curves can facilitate the identification of very slow changes in EEG background activity and their variation (alertness cycles, changes linked to treatment administrations) as well as seizure patterns and their quantification. In this chapter, we propose a brief overview of monitoring techniques, followed by a review of the various data yielded by EEG monitoring as well as the relevance of this type of management; finally, detailed clinical indications will be discussed after thorough analysis of the literature. © 2015 .
Duong-Quy S.,Service de Physiologie Explorations Fonctionnelles
Revue des Maladies Respiratoires Actualites | Year: 2011
Major advances have been made in recent years in the treatment of pulmonary hypertension with a wide range of available therapeutic option, including prostacyclins, endothelin receptor antagonists, and phosphodiesterase type-5 inhibitors. Results of clinical trials with these compounds have shown that improvements in haemodynamic parameters, exercise capacity as well as WHO functional class might be obtained. © 2011 Société de Pneumologie de Langue Française (SPLF).
Ng Wing Tin S.,University Paris Est Creteil |
Ciampi de Andrade D.,Service de Physiologie Explorations Fonctionnelles |
Ciampi de Andrade D.,University of Sao Paulo |
Goujon C.,University Paris Est Creteil |
And 3 more authors.
Clinical Neurophysiology | Year: 2014
Objective: To characterize sensory threshold alterations in peripheral neuropathies and the relationship between these alterations and the presence of pain. Methods: Seventy-four patients with length-dependent sensory axonal neuropathy were enrolled, including 38 patients with painful neuropathy (complaining of chronic, spontaneous neuropathic pain in the feet) and 36 patients with painless neuropathy. They were compared to 28 age-matched normal controls. A standardized quantitative sensory testing protocol was performed in all individuals to assess large and small fiber function at the foot. Large fibers were assessed by measuring mechanical (pressure and vibration) detection thresholds and small fibers by measuring pain and thermal detection thresholds. Results: Between patients with neuropathy and controls, significant differences were found for mechanical and thermal detection thresholds but not for pain thresholds. Patients with painful neuropathy and those with painless neuropathy did not differ regarding mechanical or thermal thresholds, but only by a higher incidence of thermal or dynamic mechanical allodynia in case of painful neuropathy. Pain intensity correlated with the alteration of thermal detection and mechanical pain thresholds. Conclusions: Quantitative sensory testing can support the diagnosis of sensory neuropathy when considering detection threshold measurement. Thermal threshold deterioration was not associated with the occurrence of pain but with its intensity. Significance: There is a complex relationship between the loss or functional deficit of large and especially small sensory nerve fibers and the development of pain in peripheral neuropathy. © 2013 International Federation of Clinical Neurophysiology.
De Andrade D.C.,Service de Physiologie Explorations Fonctionnelles |
Bendib B.,Service de Physiologie Explorations Fonctionnelles |
Hattou M.,Service de Neurochirurgie |
Keravel Y.,Service de Neurochirurgie |
And 2 more authors.
Pain | Year: 2010
Despite good clinical results, the mechanisms of action of spinal cord stimulation (SCS) for the treatment of chronic refractory neuropathic pain have not yet been elucidated. In the present study, the effects of SCS were assessed on various neurophysiological parameters in a series of 20 patients, successfully treated by SCS for mostly unilateral, drug-resistant lower limb pain due to failed back surgery syndrome. Plantar sympathetic skin response (SSR), F-wave and somatosensory-evoked potentials (P40-SEP) to tibial nerve stimulation, H-reflex of soleus muscle, and nociceptive flexion (RIII) reflex to sural nerve stimulation were recorded at the painful lower limb. The study included two recording sets while SCS was switched 'ON' or 'OFF' for 1 h. Significant changes in 'ON' condition were as follows: SSR amplitude, H-reflex threshold, and RIII-reflex threshold and latency were increased, whereas SSR latency, F-wave latency, H-reflex amplitude, P40-SEP amplitude, and RIII-reflex area were reduced. Analgesia induced by SCS mainly correlated with RIII attenuation, supporting a real analgesic efficacy of the procedure. This study showed that SCS is able to inhibit both nociceptive (RIII-reflex) and non-nociceptive (P40-SEP, H-reflex) myelinated sensory afferents at segmental spinal or supraspinal level, and to increase cholinergic sympathetic skin activities (SSR facilitation). Complex modulating effects can be produced by SCS on various neural circuits, including a broad inhibition of both noxious and innocuous sensory information processing. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Changes in fibroblast growth factor 23 levels in normophosphatemic patients with chronic kidney disease stage 3 treated with lanthanum carbonate: Results of the PREFECT study, a phase 2a, double blind, randomized, placebo-controlled trial
Urena-Torres P.,Service de Nephrologie Dialyse |
Prie D.,Service de Physiologie Explorations Fonctionnelles |
Keddad K.,Shire Inc |
Preston P.,Shire Inc |
And 3 more authors.
BMC Nephrology | Year: 2014
Background: High levels of circulating fibroblast growth factor 23 (FGF23) are associated with chronic kidney disease (CKD) progression and high mortality. In the Phosphate Reduction Evaluation of FGF23 in Early CKD Treatment (PREFECT) study, we assessed the effect of reducing intestinal phosphate absorption using lanthanum carbonate on FGF23 levels in normophosphatemic patients with CKD stage 3. Methods. Thirty-five individuals were randomized to lanthanum carbonate 3000 mg/day (n = 23) or placebo (n = 12) for 12 weeks. Levels of intact FGF23 (iFGF23), C-terminal FGF23, serum and urinary phosphate and calcium, intact parathyroid hormone and 1,25-dihydroxyvitamin D were assessed. Results: The median age was 65 years in the lanthanum group and 73 years in the placebo group; 58.8% and 41.7% were men, respectively. No significant difference was seen in mean iFGF23 between groups at week 12. There was, however, a transient reduction from baseline in iFGF23 in the lanthanum group at week 1, from 70.5 pg/ml to 51.9 pg/ml, which was not seen in the placebo group; this between-group difference in percentage change from baseline was significant in post hoc analyses (p = 0.0102). Urinary phosphate decreased after 1 week of lanthanum treatment and remained low at week 12. Conclusions: Reducing intestinal phosphate absorption with lanthanum carbonate did not lead to sustained reductions in iFGF23 in patients with CKD stage 3, although phosphaturia decreased. This suggests that factors other than phosphate burden may be responsible for driving increases in circulating FGF23 in patients with CKD. Trial registration. ClinicalTrials.gov NCT01128179, 20 May 2010. © 2014 Ureña-Torres et al.; licensee BioMed Central Ltd.
Lefaucheur J.-P.,Service de Physiologie Explorations Fonctionnelles |
Keravel Y.,University Paris Est Creteil |
Nguyen J.-P.,University Paris Est Creteil
Neurosurgery | Year: 2011
BACKGROUND: Chronic, drug-resistant neuropathic pain can be treated by surgically implanted motor cortex stimulation (MCS). The leads used for MCS have not been specifically designed for this application. OBJECTIVE: To study the value of a new 8-contact lead for MCS therapy in a series of 6 patients with refractory central poststroke pain. METHODS: The study comprised a 1-month randomized phase, starting 1 month after implantation, during which the neurostimulator was switched on in one-half of the patients or remained off in the other half, followed by an open phase of 10 months, during which the stimulator was switched on in all patients. Clinical assessment was performed at baseline and 1, 2, 3, 6, and 12 months after implantation with the following scales: Visual Analog Scale, Verbal Rating Scale, Brief Pain Inventory, McGill Pain Questionnaire, Sickness Impact Profile, and Medication Quantification Scale. RESULTS: In the randomized phase, clinical scores were found to be globally reduced in the on- vs off-stimulation condition. In the open follow-up phase, all clinical scores improved significantly over time. The ratio between affective and sensory McGill Pain Questionnaire subscores decreased, suggesting a preferential effect of MCS on the affective component of pain. Compared with preoperative baseline, 2 patients were totally relieved of central poststroke pain, 3 patients were very much relieved, and 1 patient remained unchanged at the final examination. CONCLUSION: A good clinical outcome was observed in all patients except 1, suggesting that this new octopolar lead could be used for MCS therapy to treat refractory central poststroke pain. Copyright © 2011 by the Congress of Neurological Surgeons.